- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.84 / $1,688.00 / $9,477.00
| Facility | | $186.84 | $1,688.00 | $9,477.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.83 / $186.84 / $214.76
| Professional | | $147.83 | $186.84 | $214.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.11 / $181.47 / $181.47
| Professional | | $137.11 | $181.47 | $181.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.62 / $266.68 / $338.59
| Professional | | $195.62 | $266.68 | $338.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $1,056.00 / $2,558.00
| Facility | | $375.00 | $1,056.00 | $2,558.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.87 / $239.67 / $329.91
| Professional | | $153.87 | $239.67 | $329.91 |